Revisiting the orthopaedic management of metastatic renal cell carcinoma: rationale for a more aggressive approach

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The treatment and management of renal cell carcinoma (RCC) has recently undergone dramatic changes in every sense, including diagnosis, prognostication, and treatment. Even with these improvements, the incidence of the disease continues to rise, and osseous metastasis remains a challenge in 14% of RCC patients. Building upon the substantial durable response to high-dose Interleukin-2 (HD IL-2) and Interferon-[alpha] (IFN-[alpha] combination treatment seen within a subset of patients, novel targeted therapies are rapidly evolving and offering real, albeit incremental, improvements in progression free survival (PFS) and overall survival (OS). These improvements, coupled with the realized benefit of improved diagnostics, more accurate patient stratification schemas, and the development of stereotactic body radiation therapy (SRBT) as a more efficacious method of delivering radiation, underscore the multidisciplinary advancement in the nonoperative management of RCC currently underway. In the context of these advances, the role of the orthopaedic surgeon in the management of the solitary metastases, oligometastatic disease, and disseminated disease may need to be revisited, in so far as to support more aggressive surgical resections and provide more durable and reliable orthopaedic reconstructions while employing all of the multidisciplinary tools available.

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